Wellbeing change in response to work exit and lifecourse determinants of resilience in Europe Sol Richardson Supervisors: Professor Amanda Sacker Professor Gopalakrishnan Netuveli Dr Ewan Carr Thesis submitted for the degree of Doctor of Philosophy Research Department of Epidemiology and Public Health, University College London ACKNOWLEDGEMENTS ACKNOWLEDGEMENTS This work was supported by a centre-linked grant from the Economic and Social Research Council (ESRC, Award Numbers ES/J500185/1 and ES/J019119/1). I am particularly grateful to the ESRC and UCL. In addition to the stipend which allowed me to carry out this work, I would like the thank the ESRC for providing substantial additional funding to support training in advanced quantitative methods at external courses in Cambridge and Manchester, and for travel expenses for attending conferences to make presentations. UCL, meanwhile, has provided manifold opportunities for enrichment both inside and outside the walls of 1–19 Torrington Place. These not only included an impressive range of research-related courses, but also opportunities to explore new subjects; for example, during Russian lessons at the School of Slavonic and East European Studies and an exchange at the London Business School where I took an elective in project management. I would like to acknowledge the individuals who made this thesis possible. First among these people are my supervisors, Professor Amanda Sacker, Professor Gopal Netuveli and Dr Ewan Carr, to whom I am extremely grateful for contributing their time, energy and ideas. My upgrade report examiner, Professor Tarani Chandola, also had an important role to play in influencing the direction of my project. I would also like to thank my examiners, Professor Martin Bobak and Professor Pekka Martikainen, for their comments. During my studies I feel that I benefited immensely from being part of the International Centre for Lifecourse Studies, and I would like to thank the friends and colleagues I met along the way. My contacts with them, both on more formal occasions such as the weekly seminars, quarterly centre days and annual Cumberland Lodge retreats, and also on an informal day-to-day basis, were instrumental in informing my research ideas and supporting me through the PhD. Together with my wider group of colleagues in the Department of Epidemiology and Public Health, they immeasurably enhanced my experience over the past 42 months. Finally, I derived great pleasure from interacting with the wider community of social epidemiology researchers during seminars and conferences both in the UK and overseas, and they have motivated me to consider the wider context and implications of my own work. 3 DECLARATION OF ORIGINALITY I, Sol Richardson, declare that the contents of this thesis are my own work. Where the work of others has been used, this has been indicated and appropriately referenced. COPYRIGHT DECLARATION The copyright of this thesis rests with the author and is made available under a Creative Commons Attribution Non-Commercial No Derivatives licence. Researchers are free to copy, distribute or transmit the thesis on the condition that they attribute it, that they do not use it for commercial purposes and that they do not alter, transform or build upon it. For any reuse or redistribution, researchers must make clear to others the licence terms of this work. 4 ABSTRACT ABSTRACT Background and aims: ‗Resilience‘ is positive adaptive process in the context of exposure to a risk factor or event. Its opposing term is ‗vulnerability‘. Retirement, and exit from work in early old age in general, is an important age-graded transition and potential risk factor in terms of wellbeing and mental health. This transition, which varies substantially between individuals and different country contexts, is historically and socially embedded. Defining resilience in terms of wellbeing change following exit from paid work, this thesis aimed to examine its associations with individual-level variables at the time of work exit, country-level variables, and retrospective measures of adversity over the lifecourse. Data sources: Data from 10,195 respondents were drawn from Waves 1–5 (2004–2013) of the Study of Health, Ageing and Retirement in Europe (SHARE) and Waves 1–6 (2002– 2013) of the English Longitudinal Study of Ageing (ELSA) aged over 50 years who had two or more consecutive waves of observations and who had exited from work since the previous wave. Retrospective life history data were collected as part of ELSA Wave 3 (2006–2007). Methods: Using CASP-12 change scores between waves as the outcome measure, individual-level factors, including institutionally-defined route and timing of work exit, were tested for associations with wellbeing change (Chapter 3). Welfare state regime, social protection spending and other country-level factors were then investigated for direct associations with wellbeing change using multilevel random intercepts models. The percentage of total variance explained by country differences and the proportion of these country differences explained by groups of country-level variables was estimated (Chapter 4). Finally, lifecourse adversity measures, specifically exposure to adverse events at different ages and cumulative socioeconomic disadvantage, were considered as determinants of wellbeing and wellbeing change (Chapter 5). Results: Exit from work outside socially- and culturally-accepted norms is associated with a decline in wellbeing. When compared with on-time retirees, individuals leaving work over one year before or after their expected retirement age, or who exited work via receipt of unemployment, disability or sickness benefits, experienced more negative changes in wellbeing upon exiting paid work. 5 ABSTRACT Wellbeing change following work exit also differed significantly between countries. Although between-country differences accounted for only 7% of total variance, welfare state regime explained over 60% of the country effect. Expenditure on social protection, in particular on non-healthcare services, was associated with more positive wellbeing change following work exit. Exposure to adverse events over the lifecourse had an independent association with negative wellbeing change. This was driven by experiences in adulthood. Although lifecourse socioeconomic disadvantage was also associated with more negative wellbeing change, this was fully mediated by household income and wealth at the time of work exit. Finally, exposure to adverse events at all ages was independently and significantly associated with lower cross-sectional CASP-12 scores and higher odds of depression in old age. Conclusions: There were associations between both individual and country-level variables and resilience following work exit. Adverse events over the lifecourse predicted poor resilience, or vulnerability, during transitions from paid work in early old age. 6 CONTENTS CONTENTS 1 CHAPTER 1: Resilience ....................................................................................................... 29 1.1 RESILIENCE ................................................................................................................. 29 1.1.1 Background and development .............................................................................. 29 1.1.2 Individual resilience: A panoply of definitions .................................................. 30 1.1.3 Resilience and its definitions ................................................................................ 31 1.1.4 Evolution of the term ............................................................................................ 32 1.1.5 Resistance resources and resilience ...................................................................... 36 1.1.6 Resilience and risk .................................................................................................. 37 1.1.7 Resilience in old age ............................................................................................... 38 1.1.8 Risk and the lifecourse ........................................................................................... 39 1.1.9 Risk exposure over the lifecourse and resilience in early old age: Causal mechanisms ............................................................................................................................. 42 1.1.10 Risk exposure over the lifecourse and resilience in early old age: Three types of association .......................................................................................................................... 47 1.2 RESEARCH GAPS ....................................................................................................... 51 1.3 AIMS AND OBJECTIVES OF THE DOCTORAL PROJECT .......................... 52 1.3.1 Study aims ............................................................................................................... 52 1.3.2 Study objectives ...................................................................................................... 52 2 CHAPTER 2: Data Sources and Methods ......................................................................... 55 2.1 INTRODUCTION........................................................................................................ 55 7 CONTENTS 2.2 DATA SOURCES .......................................................................................................... 55 2.2.1 The Survey of Health, Ageing and Retirement in Europe (SHARE) ............. 55 2.2.2 The English Longitudinal